Health Equity blog

On June 30, New Jersey enacted a mandatory annual fee (ranging from $325 to $725 per Medicaid covered employee and dependent) to be paid by companies that have at least 50 employees enrolled in Medicaid. Proponents of the fee initiative believe it will help pay for the state’s share of the Medicaid program’s costs, particularly as federal policy changes are expected to make the program more expensive. Proponents further argue that the fee initiative is fair, as employers benefit financially from having fewer employees enrolled in their health insurance plans. Opponents, however, argue that the fee initiative is an unfair penalty on employers, and could lead to employers hiring fewer Medicaid-eligible employees or employees foregoing enrollment in Medicaid knowing it would make them less attractive to employers, notwithstanding statutory prohibitions against such adverse employment action. Other states are considering taking actions similar to New Jersey.

A new study of breast, pancreatic, and prostate cancer patients published in May found that clinically meaningful racial differences in time to pain medication initiation and strong opioid prescribing were observed for breast and prostate cancer. Black and Asian patients experienced delays in pain management, and Asian patients consistently received fewer strong opioid prescriptions. The findings highlight that inequities in pain management vary across the type of cancer and categories of pain medication. Moreover, they demonstrate the need for cancer interventions to be more culturally informed to promote equitable symptom management.

A Health Affairs policy brief published on June 11 describes how discrimination against older adults is commonplace in health care settings, negatively affecting health care quality, use, and costs as elderly patients face such problems as inappropriate care and undertreatment. Recommendations from the study to counteract ageism in health care delivery include strengthening the geriatric care workforce through specific training and implementing new health care delivery models that ensure more appropriate care for older patients. Ageism is a vital, though historically often overlooked, component of diversity, equity, and inclusion (DEI) programs. As reported in our Health Equity Blog last month, the Trump administration has acted to eliminate DEI initiatives and programs within the federal government, including eliminating the collection of data previously aimed at addressing disparities in health outcomes. These rollbacks may make effectively combatting ageism in health care even more arduous.

In early May, the Department of Justice (DOJ) sent letters to the schools of medicine at both Yale University and the University of California, Los Angeles (UCLA), notifying them that it has found, in the course of its compliance review, that the schools’ admissions decisions “intentionally discriminate against applicants based on their race.” The DOJ’s letters follow the U.S. Supreme Court’s decision in Students for Fair Admissions Inc. v. President & Fellows of Harvard College, 600 U.S. 181 (2023), holding that certain race-conscious admissions programs in higher education are unconstitutional and in violation of Title VI of the Civil Rights Act of 1964. The DOJ’s actions could jeopardize medical schools’ ongoing efforts to diversify the physician workforce. Such diversification is often viewed as one means by which to effectively improve health outcomes for minority and other underserved populations.

Numerous nursing associations have joined a federal lawsuit launched by several Democrat-led states in response to the Department of Education’s final rule that removes advanced nursing degrees from the definition of “professional degree” for federal student loan purposes. Absent such inclusion, nurses seeking post-baccalaureate nursing degrees will be subject to the $100K aggregate cap on federal loans for graduate education. This move could force many graduate nursing students to rely upon high-interest loans or forego furthering their education altogether. In turn, fewer advanced practice nurses (APNs) may enter the workforce in coming years, threatening an already severe shortage of primary care practitioners. The Department of Education claims the rule will incentivize institutions to control increasing tuition costs. The rule goes into effect July 1.

Early in his second term, President Trump issued a flurry of Executive Orders and directives targeting the elimination of diversity, equity, and inclusion (DEI) initiatives and programs within the federal government. KFF reports that these policies – despite the myriad of court orders and other legal challenges following in their wake – are having widespread implications, including reductions in research and interventions previously aimed at addressing disparities in health outcomes. Moreover, the report indicates the Administration’s actions to suspend certain national surveys and omit DEI-related data elements have also compromised the integrity and accessibility of public health information, the effects of which could jeopardize the validity and accuracy of future health care-related research.

The Centers for Medicare & Medicaid Services (CMS) issued an interim final rule on June 3 that attempts to narrow the definition of “medical frailty” for purposes of determining work requirement (or community engagement) exemptions for Medicaid beneficiaries in most states. Such states must comply with the work requirement rules by January 1, 2027, including developing lists of health conditions that constitute medical frailty. However, the rule prohibits states from categorically exempting beneficiaries with those health conditions and requires them to instead evaluate an individual’s ability to satisfy the work requirement based upon their overall health. Nonetheless, through 2027, the rule permits states to accept self-declaration of work or exemption status when reliable data are not otherwise available. Key provisions of the rule can be found in CMS’s Fact Sheet.

Faced with higher premium payments without enhanced tax credits beyond 2025, plan sign-ups during the Affordable Care Act’s (ACA) Marketplace 2026 open enrollment period dropped by over a million. And the rates of effectuated enrollment, i.e., how many individuals will actually pay their premiums following enrollment, may be even lower. That number could plummet to a monthly average that is 6 million fewer than in 2025. KFF reports that enrollee premium costs increased by an average of 58%, from $113 to $178 per month in 2026, while deductibles increased by 37% ($1,027 per person) to a record high of $3,786.

The most recent annual report by the Commonwealth Fund, which analyzes health disparities nationwide, found that American Indian/Alaska Native, Black, and Hispanic communities generally experienced worse access to, and affordability of, health care services in most states during 2023–24. The report anticipates that these disparities will only worsen due to major federal funding cuts and changes to Medicaid and the Affordable Care Act (ACA) marketplace, while also highlighting the potential for artificial intelligence to help close gaps in care. Notably, the report assigns each racial and ethnic group in every state an overall health system score based on the state’s combined performance in health outcomes, access to care, quality of care, and individuals’ use of health services.

A UnidosUS report claims that the progress made in Latino health care during the past decade is threatened by Medicaid funding cuts in 2025 and the expiration in January 2026 of the enhanced tax credits under the Affordable Care Act (ACA). The report estimates that more than 28% of the 14 million individuals projected to lose health insurance coverage during the next 10 years will be Hispanic. States with large Latino populations, such as California and Florida, will be most impacted.